Fillable Manufacturers/Installing Contractors Report for ASME CSD-1-2012 (Office of the Chief Information Officer)

Fill Online, Printable, Fillable, Blank Manufacturers/Installing Contractors Report for ASME CSD-1-2012 (Office of the Chief Information Officer) Form

Use Fill to complete blank online OFFICE OF THE CHIEF INFORMATION OFFICER (IA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Manufacturers/Installing Contractors Report for ASME CSD-1-2012 (Office of the Chief Information Officer)

On average this form takes 31 minutes to complete

The Manufacturers/Installing Contractors Report for ASME CSD-1-2012 (Office of the Chief Information Officer) form is 2 pages long and contains:

  • 2 signatures
  • 5 check-boxes
  • 114 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Office of the Chief Information Officer

BROWSE OFFICE OF THE CHIEF INFORMATION OFFICER (IA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Unit Identification (Boiler)
Manufacturer’s
Model #
Year
Built
ASME
Section (1)
Section (IV)
National
Board #
UL #
CSA #
Jurisdiction
Unit
Description (type)
Unit
Capacity (output)
Steam Hot Water
Maximum
W.P. psig
Maximum
W.P. psig
Minimum Safety
Valve Capacity PPH
Maximum
Temperature °F
Minimum Safety
Relief Valve Capacity
PPH BTU
Burner – Indicate Units (where not applicable, indicate “N/A”)
Manufacturer
Model
UL or CSA #
Serial #
Fuels
(as shipped)
Gas Manifold
Pressure
Oil Nozzle/
Delivery Pressure (at max pressure)
High Gas Pressure
Switch Setting
Low Oil Pressure
Switch Setting
Unit Manufacturer
Name
Address
City
State
Zip
Phone
Number
Fax
Number
Installation Location
Customer
Name
Address
City
State
Zip
Phone
Number
Fax
Number
This form is a guideline and NOT part of ASME CSD-1-2012
222-02 02.15.2016 Page 1
Iowa Division of Labor
Boiler and Pressure Vessel Safety
150 Des Moines Street
Des Moines, IA 50309-1836
Phone: 515-725-5609/515-725-5610
Fax: 515-242-5076
boilers@iwd.iowa.gov
www.iowaboilers.gov
NONMANDATORY APPENDIX C
Manufacturer’s/Installing Contractor’s
Report for ASME CSD-1-2012
Certification and Reporting (CG-500) for Controls and Safety Devices
Certification and Reporting (CG-500) for Controls and Safety Devices
.
Control/Device
Manufacturer
Model
Number
Date Operational
Test Performed
Operating Controls
Low-Water Fuel Cutoff
CW-120(a), CW-140
Forced Circulation - CW-210(a)
Steam Pressure - CW-310(b)
Water Temperature – CW-410(b)
Safety Controls
Low-Water Fuel Cutoff
CW-120(a), CW-120(b), CW-130, CW-140
Forced Circulation - CW-210(b)
High Steam Pressure Limit - CW-310(c)
High Water Temperature Limit
CW-410(b)
Fuel Safety Shutoff Valve, Main
CF-180(b)(2), CF-180(b)(3)
Pilot Safety Shutoff Valve - CF-180(c)
Atomizing Medium Switch - CF-450(b)
Combustion Air Switch - CF-220
High Gas Pressure - CF-162
Low Gas Pressure - CF-162
Low Oil Pressure - CF-450(a)
High Oil Temperature - CF-450(c)
Low Oil Temperature - CF-450(d)
Purge Air Flow - CF-210
Flame Safeguard (Primary)
CF-310, CF-320
Flame Detector – CF-310, CF-320
Low Fire Start
Low-Fire Start Switch - CF-610
Safety or Safety Relief Valve(s)
CW-510, CW-520
Manufacturer
Model
Size
Capacity
PPH BTU hr
Date of Operational
Test Performed
Representing Equipment Manufacturer
Name Signature Date
Repr
esenting Installing Contractor
Name Signature Date
This form is a guideline and NOT part of ASME CSD-1-2012
Page 2
click to sign
signature
click to edit
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

ManufacturersInstalling Contractors Report for ASME CSD-1-2012 (Office of the Chief Information Officer)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 20 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document